Hepatitis A Vaccine, Inactivated (PDF) by xyi12027

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									                               Massachusetts Department of Public Health
                               Massachusetts Immunization Program (MIP)

                                   MODEL STANDING ORDERS

                                  Hepatitis A Vaccine, Inactivated

These model standing orders are current as of January 2004. They should be reviewed carefully
against the most current recommendations and may be revised by the clinician signing them.

Hepatitis A vaccination is indicated for preexposure protection from hepatitis A virus
(HAV) infection for susceptible persons ≥ 2 years of age in the following groups:

•   Persons traveling to, or working in, countries that have high or intermediate endemicity (Asia
    [excluding Japan], Africa, Central and South America, the Caribbean, Greenland, and
    Eastern Europe). The vaccine should be administered > 1 month prior to travel.
•   Men who have sex with men
•   Users of injecting and noninjecting illegal drugs
•   Persons who have clotting factor disorders
•   Persons who have chronic liver disease
•   Persons who have occupational risk for infection (work with HAV-infected primates or with
    HAV in a research laboratory setting)
•   Persons in communities where HAV outbreaks occur (if local epidemiological data indicate
    it is feasible)
•   Children who live in states, counties, or communities with high rates of HAV infection (e.g.,
    the average annual HAV infection rate during 1987-1997 was > 20 cases per 100,000
    population, or approximately twice the national average)

Hepatitis A vaccination may be considered for preexposure protection from HAV infection
in susceptible persons > 2 years of age in the following groups:

•   Persons who work in food-service establishments or who are food handlers (if local
    epidemiological data determine it is cost effective)
•   Child care center staff and attendees with ongoing or recurrent outbreaks (if indicated by
    local epidemiological data)
•   Children who live in states, counties or communities with intermediate rates of HAV
    infection (e.g., the average annual rate of HAV infection during 1987-1997 was 10 – 19
    cases per 100,000 population, or approximately the national average
•   Any person wishing to obtain immunity

ORDER:
________________________________________________                    ____/____/____
Clinician’s Signature                                               Date

Standing Order – Hepatitis A                      Page 1 of 5                         January 2004
1. Provide patient, parent or legal representative with a copy of the Vaccine Information
   Statement (VIS) and answer any questions.
2. Screen for contraindications according to Table 1.
3. Give the correct dose of hepatitis A vaccine intramuscularly (IM) according to the
   recommended schedule (see Table 2) Always check the package insert prior to
   administration of any vaccine. Administer IM vaccines at a 90o angle with a 22- to 25-
   gauge needle.
    a. Toddlers (> 2 years of age) and older children: Administer in to the anerolateral aspect of
       the thigh or deltoid, using a 7/8- to 1¼-inch needle, depending on the size of the muscle.
       For toddlers, you can use the anterolateral thigh, but the needles should be longer, usually
       1 inch. The deltoid is preferred for immunization of adolescents.
    b. Adolescents and young adults (< 18 years of age): Administer in the deltoid using a 1- to
       2-inch needle, depending on the vaccine recipient’s weight (1 inch for females < 70 kg;
       1.5 inches for females 70-100 kg; 1 to 1.5 inches for males < 120 kg; and 2 inches for
       males > 120 kg and females > 100 kg).
    c. Adults > 18 years of age: Administer in the deltoid using a 1- to 2-inch needle, depending
       on the vaccine recipient’s weight (1 inch for females < 70 kg; 1.5 inches for females 70-
       100 kg; 1 to 1.5 inches for males < 120 kg; and 2 inches for males > 120 kg and females
       > 100 kg).


4. Administer hepatitis A vaccine simultaneously with all other vaccines indicated according to
   the recommended schedule and the patient’s current vaccine status.
5. If possible, observe patient for an allergic reaction for 15 - 20 minutes after administering
   vaccine.
6. Facilities and personnel should be available for treating immediate hypersensitivity reactions.
7. Report clinically significant adverse events to the Vaccine Adverse Event Reporting System
   (VAERS) at 1-800-822-7967, or via the VAERS website: www.vaers.org.
8. Please see the MIP document, General Protocols for Standing Orders, for further
   recommendations and requirements regarding vaccine administration, documentation, and
   consent.




             Table 1.      Contraindications and Precautions to Hepatitis A Vaccine

________________________________________________                  ____/____/____
Clinician’s Signature                                             Date

Standing Order – Hepatitis A                    Page 2 of 5                           January 2004
     Valid Contraindications to Hepatitis A                       Invalid Contraindications
                     Vaccine                            (hepatitis A vaccine should be administered)
Anaphylactic reaction to previous dose of               Mild illness with or without low-grade fever
hepatitis A vaccine, alum, 2-phenoxyethanol             Non-anaphylactic allergy to any component for
(Havrix® only)1, neomycin (Havrix® only), latex         the vaccine
(VAQTA® only)2, or to any other component of
                                                        Local reaction to a previous dose of hepatitis A
the vaccine (see package insert for specific
                                                        vaccine
components)3
                                                        Immuosuppression
Precautions to Hepatitis A Vaccine:                     Personal or family history of non-specific
• Moderate-to-severe acute illness, with or             allergies
   without fever (temporary precaution)                 Current antimicrobial therapy
             4
• Pregnancy


1
  Persons with a hypersensitivity to 2-phenoxyethanol should receive VAQTA®, the Merck
preparation, which does not contain 2-phenoxyethanol.
2
  Persons with hypersensitivity to latex should receive Havrix®, the SmithKline Beecham
preparation, which does not contain latex.
3
  Persons with a history of anaphylaxis to a vaccine component, but who are at high risk for
hepatitis A disease, should be referred to a health care provider for evaluation and possible
administration of hepatitis A vaccine.
4
  Hepatitis A vaccine should be considered for pregnant women at increased risk for hepatitis A
infection.


            Table 2.    Recommended Dosages and Schedule for Hepatitis A Vaccine

         Age           Dose (Units)            Volume            No.of            Schedule
       (Years)     Havrix®1 VAQTA®2             (mL)            Doses3,4         (Months)4
        2 - 18       720         25              0.5              2                0, 6-12
         > 18        1,440          50            1.0              2               0, 6-12

1
    Hepatitis A vaccine, inactivated, SmithKline Beecham
2
    Hepatitis A vaccine, inactivated, Merck & Co., Inc.
3
    Travelers should receive the 1st dose > 4 weeks prior to travel.
4
    Two doses are needed for lasting protection.

Travelers


________________________________________________                       ____/____/____
Clinician’s Signature                                                  Date

Standing Order – Hepatitis A                      Page 3 of 5                            January 2004
Vaccine
Travelers who are administered the vaccine should receive the first dose > 4 weeks prior to
travel. Studies show that only 55 – 60% of vaccine recipients have protective antibodies at 2
weeks post vaccine. Persons traveling to high-risk areas < 4 weeks after the initial dose should
be administered IG (see paragraph below), but at a different anatomic injection site. A second
dose of vaccine 6-12 months later is necessary for long-term protection.

IG
Travelers who are allergic to a vaccine component, whose time prior to departure is < 4 weeks,
or who elect not to receive the vaccine, should receive IG.
• If the travel period is < 3 months in duration, travelers should receive a single dose of IG
    (0.02 mL/kg), which provides protection against hepatitis A for up to 3 months.
• If the travel period is > 3 months in duration, travelers should receive IG at 0.06 mL/kg,
    which provides protection for up to 5 months. At this time, administration of IG must be
    repeated.

Pre- and Post-Vaccination Serologic Testing for Susceptibility

1. Prevaccination testing of children is not indicated because of their expected low prevalence of
   infection. Prevaccination may be cost effective when the prevalence of hepatitis A virus
   infection is > 33%. Persons for whom testing might be indicated include:
• adults who are either born in, or lived for extensive periods in, geographic areas with high
     endemicity of HAV infection;
• older adolescents and adults in certain population groups (i.e., Native Americans, Alaskan
     Natives, and Hispanics);
• adults in certain groups that have a high prevalence of infection (see above); and
• adults > 40 years of age.

2. Postvaccination testing is not indicated because of the high rate of vaccine response among
   adults and children.




References:
________________________________________________                  ____/____/____
Clinician’s Signature                                             Date

Standing Order – Hepatitis A                   Page 4 of 5                           January 2004
ACOG (American College of Obstetricians and Gynecologists). Immunization During
Pregnancy. ACOG Committee Opinion No. 282, January 2003.

American Academy of Pediatrics. Active and Passive Immunization. Hepatitis A. Immunization
in Special Clinical Circumstances. Standards for Child and Adolescent Immunization Practices
(Appendix II). In Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious
Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003: 7-53, 53-63,
309-318, 66-93, 795-798.

CDC. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 8th ed.
Atlanta, Georgia: Department of Health and Human Services; 2004.

CDC. General recommendations on immunization: recommendations of the Advisory Committee
on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP).
MMWR 2002; 51 (No. RR-2):1-35.

CDC. Guide to contraindications to vaccinations. U.S. Department of Health & Human Services,
September 2003.

CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the
Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48 (No. RR-12):1-38.

CDC. Recommended adult immunization schedule – United States, 2003-2004. MMWR
2003;52:965-969.

CDC. Recommended childhood and adolescent immunization schedule - United States, Jan –
June 2004. MMWR 2004;53:Q1-Q4.

CDC. Update: vaccine side effects, adverse reactions, contraindications, and precautions:
recommendations of the Advisory Committee on Immunization Practice (ACIP). MMWR
1996;45(No. RR-12):10-22.
National Vaccine Advisory Committee. Standards for child and adolescent immunization
practices. Pediatrics 2003;112:958-963.

Poland GA, Shefer AM, McCauley M, Webster, PS, Whitley-Williams PN, Peter G, and the
National Advisory Committee. Standards for adult immunization practices. Am J Prev Med
2003;25:144-150.




________________________________________________                ____/____/____
Clinician’s Signature                                           Date

Standing Order – Hepatitis A                   Page 5 of 5                          January 2004

								
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